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State of Health Care: Political uncertainty, health-tech and battles over patients

To kick off 2018, Poughkeepsie Journal and Journal News reporters are assessing the state of critical issues on their beats. In this story, investigative reporter David Robinson looks at the state of health care and the business of health care in the Hudson Valley.

In our latest topic, health care, the coming year seems pivotal to the future of American medicine.

For many New Yorkers, health care decisions are made one day at a time. From rich to poor, most struggle to plan for long-term medical needs and costs. They’re forced to react as health insurance coverage undergoes drastic swings and hospitals across the United States battle over patients.

From the national landscape to the local scene in Dutchess, Westchester and Rockland counties, our latest subject will bring you the top health-related issues, the key figures who will drive decisions and milestone dates to watch for during 2018.

On the beat

Many New Yorkers are paying more for health insurance and getting less coverage thanks to high-deductible plans, rising premiums and out-of-network rate hikes. Experts are blaming a big part of these changes on political upheaval that reduced subsidies, diluted healthy patient pools and turned sacred cow health programs into legislative bargaining chips.

All the uncertainty comes as some Hudson Valley health providers are rapidly approaching fiscal cliffs. Many made risky bets to keep pace with health-tech price spikes, consolidation wars and the Big Pharma battlefield that produces life-saving medicines at unaffordable prices for many patients and insurers.

Further, chronic illnesses like obesity, diabetes and addiction are spreading at historic rates across all walks of life. The trend has put unprecedented pressure on the entire medical system. Health economists are concerned about the future stability of Medicare and Medicaid as the costs of drugs, hospitals and public-health programs head down unsustainable paths.

Meanwhile, President Donald Trump and GOP members of Congress have vowed to reduce federal government’s role in American health care in 2018 and beyond, an outcome that does outsized harm to states like New York that have comparatively high health-care costs and low uninsured rates.

President Donald Trump in April speaks at the Interior Department in Washington. Among the likely winners in Trump’s tax-cut plan is Trump himself.(Photo: Carolyn Kaster, AP)

What follows are key details about the political, social and economic battles looming over these complex issues during the coming weeks and months. The outcomes touch all aspects of life in the Hudson Valley and beyond.

What to watch for

How President Donald Trump’s tax overhaul and health subsidy cuts affect health care. The tax reforms eliminated the individual mandate and weakened the Affordable Care Act, while the GOP-led Congress pushed an agenda focused on reducing federal funding for a range of health programs, from the Children’s Health Insurance Program to Medicare.

Medicaid and federal budget cuts threat to New York. The government-run health programs insuring millions of poor and disabled in New York are expecting cuts in federal aid. Lawmakers have offered up dire warnings that state and local governments may have to fill budget gaps in excess of $1 billion to avoid cutting coverage to hundreds of thousands of New Yorkers.

The opioid epidemic is getting worse instead of better. Drug overdose deaths are increasing in New York and across the country, despite public-health campaigns targeting the problem. U.S. life expectancy is down as a result of the historic drug crisis, and addiction treatment experts are calling for major government investments to turn the tide.

Single-payer, or universal government-run health care, is alive and well amid opposition to Trump-led health care overalls. New York and California have separate state legislation seeking to be the first single-payer model in the nation. At the federal level, lawmakers pushed a Medicare-for-All bill that would expand the long-standing health program for the elderly and disabled to the rest of the population.

Why you should care

Health care is seemingly at an once-in-a-lifetime crossroads. After decades of failure, the Affordable Care Act in 2010 was the most significant change since 1965, when lawmakers created Medicare and Medicaid. The Affordable Care Act, commonly called Obamacare, survived the GOP and Trump reform bids in 2017, but faces a bleak outlook in 2018 and beyond. What unfolds in the coming year will likely redefine how American medicine functions going forward, as politicians and health industry players fight over the fate of one-fifth of the U.S. economy and overall public well-being.

New York Gov. Andrew Cuomo delivers his state of the state address at the Empire State Plaza Convention Center on Wednesday, Jan. 3, 2018, in Albany, N.Y. (AP Photo/Hans Pennink)(Photo: Hans Pennink, AP)

Key players

Gov. Andrew Cuomo of New York. He has emerged as a leading opponent to the Trump administration, pledging to fight the tax overhaul and health care reforms as unjust and targeted attacks on New York and other Democratic-leaning states.

Dr. Steven Safyer, president and CEO of Montefiore Health System, the Bronx-based health system with 11 hospitals, including St. Luke’s Cornwall Hospital, and a national leader in community-based programs seeking to reduce costs and improve patient outcomes. Montefiore also controls a significant market share across the greater New York metro area.

Robert Friedberg, president and CEO of Health Quest Systems, the Poughkeepsie-based health system that includes Vassar Brothers Medical Center, Northern Dutchess Hospital in Rhinebeck and Putnam Hospital in Carmel. Vassar Brothers is in the midst of a $500 million expansion that is a risky bet for Health Quest, which has recently added Sharon Hospital in Connecticut.

Michael Israel, president and CEO of WMC Health, the Vallhalla-based health system anchored by Westchester Medical Center, the Hudson Valley’s only top-level trauma center that recently had a major overhaul. The 10-hospital system has been expanding its footprint into Dutchess, Ulster, Rockland and Orange counties.

Key dates

Jan. 19: Next deadline for passing a federal budget to avert a government shutdown. Among the many issues is the fate of federal funding levels for health programs affecting millions of Americans.

April 1: New York State budget deadline. After spending down recent one-time windfalls, New York likely faces a $1 billion-plus budget gap in the coming fiscal year.

Nov. 6: Election Day. The battle for control of state and federal governments is expected to be fierce, and health care, as has often been the case, is a key issue for voters.

By the numbers

78.6 years: The average life expectancy for a baby born in the United States in 2016. It is a decrease of more than a month from 2015 and more than two months from 2014. That’s the first two-year decline since 1962 and 1963 when spikes in flu deaths were likely to blame. Experts blamed the recent drop on the opioid epidemic.

7: The number of Americans dying of a drug overdose every hour on average. As a result, drug overdose is now the leading cause of death for Americans under the age of 50.

9 million: The tally of children nationally in the Children’s Health Insurance Program, which provides subsidized health care for children in families with incomes that are low but too high to qualify for Medicaid. It includes 350,000 New Yorkers and is one of many issues left in limbo by federal budget inaction.

130 million. The number of Americans who have one or more chronic medical conditions, accounting for about 86 percent of the $3 trillion spent on health care in the United States, according to federal studies. In New York, more than 40 percent of adults suffer from a chronic disease.

Investigative reporter David Robinson has been covering health care for six years in several states. He has interviewed countless patients, doctors, and hospital and insurance company executives. He won the 2015 New York Associated Press award for investigative reporting.